Objective: To optimize the dosage of foslevodopa/foscarbidopa continuous subcutaneous infusion (CSCI) therapy for Parkinson’s disease by identifying dosage differences between the continuation and discontinuation groups.

Background: CSCI is the most recently introduced device-aided therapy for Parkinson’s disease. However, the appropriate patient population for this treatment, particularly in terms of prior oral medication regimens, and optimal drug dosage adjustments remain to be clarified.

Method: Patients who received CSCI treatment were selected from the prospective Parkinson’s disease cohort at Osaka University Hospital. Baseline clinical data, including LEDD before CSCI initiation, drug dosage trends, and treatment discontinuation, were analyzed. The dosage of CSCI over time and reasons for treatment discontinuation were also examined.

Results: A total of 19 patients who received CSCI treatment were included in the analysis. Seven patients discontinued CSCI, with a median treatment duration of 12 days (IQR: 9–103). Before CSCI initiation, the continuation group had a significantly lower levodopa equivalent daily dose (LEDD) than the discontinuation group (1229 ± 350 mg vs. 1623 ± 277 mg, p < 0.05), as well as a lower levodopa + COMT inhibitor dose (781 ± 300 mg vs. 1089 ± 233 mg, p < 0.05) (Fig.1). After CSCI initiation, the overall drug dosage tended to increase in both groups to maintain the “ON” state, but the rate of dose escalation was significantly higher in the discontinuation group (Fig. 2). Despite this rapid increase, patients in the discontinuation group were unable to achieve a satisfactory therapeutic response and eventually discontinued treatment due to inadequate symptom control (n=4), skin-related complications (n=2), hallucinations (n=2), and dyskinesia (n=1).

Conclusion: Patients who discontinued CSCI had a higher initial LEDD and required more frequent dose escalation before stopping treatment. Higher oral levodopa doses at baseline may be associated with an insufficient therapeutic response to CSCI.

Fig.1 Total LEDD and L-Dopa+COMT LEDD before CSCI

Fig2. Time course of CSCI LEDD

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dosage-optimization-and-treatment-outcomes-of-foslevodopa-foscarbidopa-continuous-subcutaneous-infusion-in-parkinsons-disease-a-single-center-study/